#/Complexity of problems addressed


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If a patient is following up from surgery several months out, and is still experiencing pain, would this be considered a stable chronic illness? Thanks for your help!


True Blue
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Depending on the context, it would most likely be stable chronic illness (level 3) or chronic illness with exacerbation, progression, or side effects of treatment (level 4).
If they improved, then pain returned, or pain moderately increased, I would call that level 4.
If pain prior to surgery was 4, and now it's 2 and the goal was to reduce pain, I would call it stable and level 3.
If their pain went from a 1 to a 9, I would call it level 5 - chronic illness with severe exacerbation or progression.
When treatment goals are not met, it is not considered stable. If the goal of surgery was to reduce or eliminate pain and that has not occurred, it is not a stable illness.

From AMA (page 4):
Stable, chronic illness: A problem with an expected duration of at least a year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as chronic whether or not stage or severity changes (eg, uncontrolled diabetes and controlled diabetes are a single chronic condition). ‘Stable’ for the purposes of categorizing medical decision making is defined by the specific treatment goals for an individual patient. A patient that is not at their treatment goal is not stable, even if the condition has not changed and there is no short-term threat to life or function. For example, a patient with persistently poorly controlled blood pressure for whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic. The risk of morbidity without treatment is significant. Examples may include well-controlled hypertension, non-insulin dependent diabetes, cataract, or benign prostatic hyperplasia.

https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf starting page 3, AMA elaborates on acute vs chronic, etc.